quite the day in the clinic today. depressing. two patients came in with malaria...one was an old man and the other was a child. the man could barely stand unassisted and the blood smear showed that he was pretty far along. it's almost as if malaria is the default diagnosis here. the treatment is fairly simple, just 3 days, 10 pills (chloroquine), which is why it is such a shame that so many people die of the disease...but here people wait til things get REALLY bad before taking the long trip to a clinic which are few and far between. there's no concept of preventative medicine here, so it is more of a battlefield-like triage where you have to deal with the most salvagable and work from there...
two women came in today with huge masses in their breasts and we sent them off to port au prince for more testing. i asked what would happen if they found out that the lumps were malignant, what steps they take for cancer here... it turns out that basically you know you have cancer and that's about it. one of the girls was only 14 and she thought it was bc her father had hit her there. it sheds a little light on why 2/3 of Haiti's population is under the age of 25.
a mother returned with her sick baby that we had seen on friday...she had been diagnosed with pneumonia and had gotten a prescription for 4 meds. when she returned today (3 days later) the child was hanging flaccid in her arms like a baby doll. she was burning up and it was as if she was dead in her mothers arms. it was so sad to see that. apparently the mother couldn't afford the meds on friday so she found the money over the weekend and bought them today. meanwhile, her child had not eaten anything since thursday, could barely breathe, and was severely dehydrated. the way the clinic works is that there is a nominal fee, but if the patient can't afford that then the mission will pay for it. no patient is ever turned away and the only reason for the small fee is to discourage those who are not really sick. if this mother had let us know that she was already unable to feed her other 4 children at home on friday, then the mission would have paid and the child would not be in the shape she was today. we were lucky bc it could have been much worse...
today i got a major dose of haitian reality and what a death sentence any infection could be. dr. cheryl had me go into a side room with one of the haitian nurses (who only spoke kreyol) to watch her change a patients dressings. she told me that it was something that she thought i should see and that i should understand that it is a haitian reality. the patient was a boy who looked to be a little younger than me and both his ankles were wrapped. at first i thought that his legs were completely atrophied because all i could see was his skin and bones and then i realized that his whole body was like that and he was completely starving. i introduced myself and he smiled and told me his name. he of course only spoke kreyol, but it turned out that he was only 22. then the nurse started unwrapping his gauze and what i saw was the most disturbing thing that i had ever seen in my life. he immediately looked at my face to gauge my reaction which i tried unsuccessfully to mask. his skin had been completely eaten away to the bone on both ankles. what he had was a clostridia infection (ie. gas gangrene, ie. flesh-eating bacteria) which had literally burrowed holes into his legs, exposing all the deep tissues. his skin was completely distorted around the gashes and he was oozing from everywhere. i tried not to react to much, but my breath was caught in my throat. i helped the nurse prepare to clean and i tried to comfort him, he was calm and ready. the nurse poured hydrogen peroxide all over his legs and it fizzed out of the gashes like a science fair volcano. his whole body tensed up in pain and he made a clicking noise in his throat to stop from crying out. i held his hand bc it was the only thing i could do. the nurse took a break and his whole body relaxed a bit. the next step she had to physically rub out the wounds which consisted of actually digging into the pits. i've never seen someone in so much pain EVER. his whole body contorted in agony and he was sweating and screeching as she dug in. he was squeezing my hand so hard i thought he was going to break every bone in it...it was like he was convulsing and it was a struggle to keep him down. at one point i was able to pry his hands from mine and let him grab my leg instead so he wouldn't crush my hand. i've never felt so helpless and unable to help someone. i felt like i was witness to a torturing that i was just letting happen. i felt all the blood drain from my face and i broke out in a cold sweat and had to catch myself on the table. it seemed like forever before the treatment was over, but i think when it was through we both breathed for the first time. and then he actually looked at me and apologized...i hadn't even realized that i had started crying, but i was at such a loss for the whole episode. no anesthesia, no explanation, no fault of his own... a starving destitute haitian who will probably die from this infection very soon. his prescription of clindamycin at this point is a joke and even if he were in the U.S. his prognosis would be bad this late in the game. the fact that the only thing that brought him to us was that his body had been eaten away to his bones is the epitome of the haitian approach to obtaining healthcare. this boy will know nothing but severe pain in the short amount of time he has left, and chances are that he has known nothing but pain thus far. he probably does not know that he is going to die. the staff at the clinic have been hardened by what they've seen, but i'm still fresh and it is difficult to handle. it's so trite to say that it's not fair, but it is just one of those things that didn't have to be. what's worse is that it happens all the time. i guess the only thing that i can do is hope he comes back and be with him for his treatment and try not to forget this moment. i sat with him for a bit in the waiting room and held his hand...i don't know anything about him, and i definitely could never understand, but hopefully he felt cared about. does anyone know how to act in such a situation?
at the end of the day when we were closing up a man came in who had been in a motorcycle accident and apparently had broken his leg in two places. his foot was retracted medially in an odd configuration so dr. cheryl had to straighten it out and stabilize it. sarah (the other intern) and i had to clean and dress his wounds (arms and legs) and neither of us really knew what to do, so we just did what we thought was logical. the man must have been in a lot of pain, but he didn't really show it...just a wince every once in a while. dr. cheryl splinted him up and then had to leave for a meeting...sarah and i stayed and fitted some crutches for him and waited around for someone to come get him. the whole time we were trying (unsuccessfully) to give him instructions in kreyol....and then at the very end he grinned at us and said "i speak english, you know." he was totally messing with us the whole time! everything lightened up after that and we learned some more kreyol. he would have to wait a day to go to the hospital in port au prince bc they wouldn't accept him at this point (pretty much everything in haiti closes at 3 so people can walk home in daylight). basically if you have an emergency in the evening you're screwed.
i'm a little overwhelmed how messed up things can be, but i have to remember that there are reasons for everything, even if it unapparent to us right now. it's disheartening to think that i really won't be able to do much for like 6 more years, i just hope that i can stay focused.
that was a long one. another big day in the clinic tomorrow. peace and bonswa.
two women came in today with huge masses in their breasts and we sent them off to port au prince for more testing. i asked what would happen if they found out that the lumps were malignant, what steps they take for cancer here... it turns out that basically you know you have cancer and that's about it. one of the girls was only 14 and she thought it was bc her father had hit her there. it sheds a little light on why 2/3 of Haiti's population is under the age of 25.
a mother returned with her sick baby that we had seen on friday...she had been diagnosed with pneumonia and had gotten a prescription for 4 meds. when she returned today (3 days later) the child was hanging flaccid in her arms like a baby doll. she was burning up and it was as if she was dead in her mothers arms. it was so sad to see that. apparently the mother couldn't afford the meds on friday so she found the money over the weekend and bought them today. meanwhile, her child had not eaten anything since thursday, could barely breathe, and was severely dehydrated. the way the clinic works is that there is a nominal fee, but if the patient can't afford that then the mission will pay for it. no patient is ever turned away and the only reason for the small fee is to discourage those who are not really sick. if this mother had let us know that she was already unable to feed her other 4 children at home on friday, then the mission would have paid and the child would not be in the shape she was today. we were lucky bc it could have been much worse...
today i got a major dose of haitian reality and what a death sentence any infection could be. dr. cheryl had me go into a side room with one of the haitian nurses (who only spoke kreyol) to watch her change a patients dressings. she told me that it was something that she thought i should see and that i should understand that it is a haitian reality. the patient was a boy who looked to be a little younger than me and both his ankles were wrapped. at first i thought that his legs were completely atrophied because all i could see was his skin and bones and then i realized that his whole body was like that and he was completely starving. i introduced myself and he smiled and told me his name. he of course only spoke kreyol, but it turned out that he was only 22. then the nurse started unwrapping his gauze and what i saw was the most disturbing thing that i had ever seen in my life. he immediately looked at my face to gauge my reaction which i tried unsuccessfully to mask. his skin had been completely eaten away to the bone on both ankles. what he had was a clostridia infection (ie. gas gangrene, ie. flesh-eating bacteria) which had literally burrowed holes into his legs, exposing all the deep tissues. his skin was completely distorted around the gashes and he was oozing from everywhere. i tried not to react to much, but my breath was caught in my throat. i helped the nurse prepare to clean and i tried to comfort him, he was calm and ready. the nurse poured hydrogen peroxide all over his legs and it fizzed out of the gashes like a science fair volcano. his whole body tensed up in pain and he made a clicking noise in his throat to stop from crying out. i held his hand bc it was the only thing i could do. the nurse took a break and his whole body relaxed a bit. the next step she had to physically rub out the wounds which consisted of actually digging into the pits. i've never seen someone in so much pain EVER. his whole body contorted in agony and he was sweating and screeching as she dug in. he was squeezing my hand so hard i thought he was going to break every bone in it...it was like he was convulsing and it was a struggle to keep him down. at one point i was able to pry his hands from mine and let him grab my leg instead so he wouldn't crush my hand. i've never felt so helpless and unable to help someone. i felt like i was witness to a torturing that i was just letting happen. i felt all the blood drain from my face and i broke out in a cold sweat and had to catch myself on the table. it seemed like forever before the treatment was over, but i think when it was through we both breathed for the first time. and then he actually looked at me and apologized...i hadn't even realized that i had started crying, but i was at such a loss for the whole episode. no anesthesia, no explanation, no fault of his own... a starving destitute haitian who will probably die from this infection very soon. his prescription of clindamycin at this point is a joke and even if he were in the U.S. his prognosis would be bad this late in the game. the fact that the only thing that brought him to us was that his body had been eaten away to his bones is the epitome of the haitian approach to obtaining healthcare. this boy will know nothing but severe pain in the short amount of time he has left, and chances are that he has known nothing but pain thus far. he probably does not know that he is going to die. the staff at the clinic have been hardened by what they've seen, but i'm still fresh and it is difficult to handle. it's so trite to say that it's not fair, but it is just one of those things that didn't have to be. what's worse is that it happens all the time. i guess the only thing that i can do is hope he comes back and be with him for his treatment and try not to forget this moment. i sat with him for a bit in the waiting room and held his hand...i don't know anything about him, and i definitely could never understand, but hopefully he felt cared about. does anyone know how to act in such a situation?
at the end of the day when we were closing up a man came in who had been in a motorcycle accident and apparently had broken his leg in two places. his foot was retracted medially in an odd configuration so dr. cheryl had to straighten it out and stabilize it. sarah (the other intern) and i had to clean and dress his wounds (arms and legs) and neither of us really knew what to do, so we just did what we thought was logical. the man must have been in a lot of pain, but he didn't really show it...just a wince every once in a while. dr. cheryl splinted him up and then had to leave for a meeting...sarah and i stayed and fitted some crutches for him and waited around for someone to come get him. the whole time we were trying (unsuccessfully) to give him instructions in kreyol....and then at the very end he grinned at us and said "i speak english, you know." he was totally messing with us the whole time! everything lightened up after that and we learned some more kreyol. he would have to wait a day to go to the hospital in port au prince bc they wouldn't accept him at this point (pretty much everything in haiti closes at 3 so people can walk home in daylight). basically if you have an emergency in the evening you're screwed.
i'm a little overwhelmed how messed up things can be, but i have to remember that there are reasons for everything, even if it unapparent to us right now. it's disheartening to think that i really won't be able to do much for like 6 more years, i just hope that i can stay focused.
that was a long one. another big day in the clinic tomorrow. peace and bonswa.
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